What To Expect From A Lactation Consultant

By Tamara Hawkins

Breastfeeding can be a wondrous and easy experience for many families, while others need expert support to get it quite right. The early days after a mother gives birth are a critical time in establishing a comfortable breastfeeding experience for both parent and baby. That’s where IBCLCs come in. An International Board Certified Lactation Consultant is a clinical lactation specialist often playing detective to solve cases of low milk supply, painful breastfeeding, and low weight gain in infants.

There is an alphabet soup of initials of those who offer breastfeeding help. There are La Leche League Leaders (LLL), Peer Breastfeeding Counselors, breastfeeding educators (CBE), and lactation counselors (CLC). All of these professions are dedicated to support breastfeeding families; however, they have far less training than an IBCLC.

IBCLCs are clinical lactation professionals who, among other standards, have completed 90 hours of lactation-specific education, college level health science courses, 300-1,000 supervised clinical practice hours, and passed a certification exam administered by the International Board of Lactation Consultant Examiners.

Should you need to hire an IBCLC, here is what you can expect during a consultation:

1. An IBCLC’s first role is to listen to you. He or she will ask a bunch of questions related to your medical, pregnancy, and birth history. They will observe a full breastfeeding session and piece together clues helping you solve breastfeeding issues to reach your short and long term goals.

2. During the visit, the lactation consultant will perform a thorough exam of your breasts, the baby’s mouth, the baby’s behavior while breastfeeding, body strength, and structure.

3. When necessary, the IBCLC will reach out to your medical team to collaborate on a plan to improve your breastfeeding and be your advocate.

4. Your IBCLC should give you a care plan that meets your needs at the moment. The priority is to get adequate milk to the baby, building your milk supply, and then ensure that the baby is feeding perfectly at the breast. It’s important to understand that it can take several visits before a breastfeeding concern is completely resolved. Follow-up is essential to your success.

5. Don’t be upset if your IBCLC does not accept insurance and you have to pay out of pocket. Although the Affordable Care Act (ACA) states that lactation support is to be covered, most insurance companies are not inviting IBCLCs to become in-network providers and are assuming the pediatrician, obstetrician, or midwife will provide separate lactation care. Some insurance companies will offer a special out of network coverage contract good for 1-3 visits. This care plan may be referred as an “infer out.”

6. If you are not able to get your insurance company to pay your IBCLC directly, expect the IBCLC to give you a “superbill.” This a medical receipt that has the diagnosis and procedure codes for your visit. The insurance company will use this to consider reimbursement to you for your payment. You cannot request reimbursement without this form. Confirm this document will be given to you at the time of your appointment.

7. The National Women’s Law Center has an excellent handout titled “Understanding Your Coverage Under the Affordable Care Act” to help you understand your breastfeeding benefits. Use this when you need help negotiating reimbursement or direct payment with your insurance company.

There are also a few steps to consider before the baby is born to be well prepared for the realities of breastfeeding:

8. Take a breastfeeding class during your pregnancy. Most classes discuss latching the baby to your breast, making enough milk, and care for your breasts.

9. Order your breast pump from your insurance company during your third trimester so you have it before the birth of the baby. Breast pumps are covered by the ACA. Should your baby need extra milk in addition to breastfeeding because of a medical concern, you can feed your baby expressed breastmilk instead of formula.

10. Find a breastfeeding support group near you and attend at least one meeting during your pregnancy. This allows you to meet the host and other mothers in the group, and to see normal breastfeeding.

If you still struggle once your baby arrives, the early intervention of an IBCLC insures that most breastfeeding issues are solved within a few days!

Tamara Hawkins is the founder of Stork & Cradle (storkandcradle.com), a local prenatal education group specializing in childbirth classes and lactation consultation, and is currently the president of the New York Lactation Consultant Association (NYLCA), which has directory of local breastfeeding consultants and support classes. Learn more at nylca.org.

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